Provider Demographics
NPI:1306848098
Name:DOUVILLE, EMERY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:EMERY
Middle Name:CHARLES
Last Name:DOUVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 511
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2984
Practice Address - Country:US
Practice Address - Phone:503-962-1020
Practice Address - Fax:503-962-1021
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029081208600000X
ORMD17068208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026497Medicaid
OR033WCBBPBMedicare PIN
ORE87888Medicare UPIN
OR026497Medicaid